Electronic cigarette use and periodontal tissue damage: a scoping review and an evidence-informed conceptual framework.

BACKGROUND

Electronic cigarette (e-cigarette) use has increased worldwide and is often promoted as a safer alternative to conventional smoking. However, its effects on periodontal health remain incompletely understood because of heterogeneous findings. This scoping review aimed to synthesize evidence comparing periodontal health among electronic cigarette users, conventional cigarette smokers, and non-smokers and to develop an evidence-informed conceptual framework illustrating potential biological and clinical pathways linking electronic cigarette use to periodontal tissue changes.

METHODS

A scoping review was conducted according to PRISMA-ScR. PubMed, Embase, Scopus, and Google Scholar were searched for studies published between January 2015 and March 2025. Eligible studies comparing periodontal clinical outcomes and inflammatory biomarkers among electronic cigarette users, conventional smokers, and/or non-smokers were narratively synthesized, and an evidence-informed conceptual framework was developed.

RESULTS

Of 379 records identified, 10 studies met the eligibility criteria. Conventional cigarette smokers generally demonstrated greater periodontal destruction than electronic cigarette users. Electronic cigarette users frequently demonstrated intermediate periodontal findings, including increased probing depth, clinical attachment loss, plaque accumulation, and alterations in bleeding on probing and inflammatory biomarkers; however, findings varied across studies. Potential pathways involving oxidative stress, immune dysregulation, vascular alterations, impaired wound healing, and oral microbiome alterations were identified.

CONCLUSIONS

The available evidence suggests that electronic cigarette use may be associated with adverse periodontal changes compared with non-smoking, although findings are heterogeneous. The proposed evidence-informed conceptual framework integrates potential biological and clinical pathways and may guide future mechanistic, longitudinal, and multicenter research and periodontal risk assessment.